Immunization Roundup: Resources to share with families

August is National Immunization Awareness Month, an annual observance highlighting the importance of vaccinations in people of all ages.

The immunization schedule outlined by Centers for Disease Control & Prevention (CDC) and supported by the American Academy of Pediatrics (AAP) has been shown to be the most effective and safest way to protect children from potentially fatal diseases.

Nevertheless, many families lack knowledge about vaccines, especially due to the rise of misinformation on the internet.

The following is a collection of useful immunization resources—both for providers and for the families they serve—intended to encourage families to vaccinate and to quell worries brought on by vaccine myths.

General immunization references

Providers can direct families to these resources about the safety of and necessity for immunization in general.

Vaccines at a glance
This choc.org page that lays out the importance of vaccines, defines herd immunity and debunks common myths in a simple, reader-friendly way.

American Academy of Pediatrics 2019 Immunization Schedule
The CDC and AAP agreed-upon recommendations for immunizations for ages 18 and under, this resource clearly outlines timing of vaccines based by age, appropriate intervals for vaccine catch-up and special situations.

If you choose not to vaccinate your child, understand the risks and responsibilities
If parents decline recommended vaccines for their child, it is important to inform them that the decision creates major risks not only to their own child, but to every unvaccinated person they meet. This handout clearly defines the responsibilities that comes with this choice.

Condition-specific vaccine information to give to families

Diseases and vaccines that prevent them-for parents of infants and young children
This list breaks down vaccines by the conditions they prevent, including English and Spanish versions.

What vaccines does my teen need?        
Vaccines aren’t just important for babies. Teens need to be vaccinated too! Parents should be aware of vaccines that will benefit their adolescents.

The HPV vaccine: a pediatrician’s perspective
With all the talk of infant vaccinations, it’s easy to forget that some immunizations occur later in adolescence. This Kids Health blog outlines the important vaccines for teens, including meningococcus (MCV), human papillomavirus (HPV), tetanus, diphtheria and pertussis (Tdap) and others.

What parents should know about measles
Once labeled dormant in the US, measles are on the rise worldwide—most recently marked by a historically high number of cases in 2019. This Kids Health blog gives a thorough look at measles and the accompanying vaccine.

Vaccine talking points and tips for providers

American Academy of Pediatrics tips for talking to vaccine-hesitant parents
A resource for providers outlining best ways to approach parents who are hesitant to vaccinate—includes mythbusting, suggested approaches and strategies and a breakdown of types of parental attitudes toward immunizing.

Talking with parents about vaccines for infants
A guide to speaking with parents about vaccines, including common parental concerns and questions, communication strategies and suggested responses.

Presentation: 10 ways to create a culture of immunization within a pediatric practice
This CDC slide deck outlines ways hospitals can integrate accepted vaccine practices and incorporate all staff in the adoption of immunization culture.

HPV Roundup: Resources to share with families

CHOC has published a lot of information for parents about human papilloma virus, or HPV, that is informative, straightforward and useful for families with children of all ages.

There are several common misconceptions providers encounter about HPV, including who is at risk, who should receive the vaccine and the risks associated with an untreated infection.

Please feel free to share these resources with families:

Can HPV really lead to cervical cancer?

An adolescent medicine specialist at CHOC Children’s offers HPV facts and explains its link to cervical cancer.

Does my child really need the HPV vaccine?

HPV affects nearly all sexually active men and women at some point in their lives. The HPV vaccine is more effective the younger it is given.

The HPV vaccine: a pediatrician’s perspective

A CHOC Children’s pediatric resident discusses some of parents’ most frequently asked questions about the HPV vaccine and children.

HPV at a glance on choc.org

See facts and figures, an FAQ, vaccine information, common myths debunked and a pediatrician finder tool where families can learn more and get their child the vaccine.

Vaccinating your preteen

The American Academy of Pediatrics presents answers to FAQs about important adolescent immunizations, including a walk through the purpose of each, the proper timing and an in-depth look at the HPV vaccine.

5 things pediatricians should know about seizures

Seizures can bring up a lot of worries and unknowns, especially when it comes to children.

One percent of the population has epilepsy, which puts the estimated number of children with epilepsy in Orange County alone at about 7,500. It is estimated that one in five people will have a seizure at some point—whether it develops into epilepsy or not—making seizures a more common neurological condition than multiple sclerosis, Parkinson’s and Alzheimer’s disease combined.

There are many common misconceptions about seizures, even within the medical community. Dr. Mary Zupanc, pediatric neurologist and epileptologist and co-medical director of CHOC’s Neuroscience Institute, points to five important points pediatricians should consider when seeing a patient who has had one or more seizures.

Professional headshot of Dr. Mary Zupanc, Pediatric Epileptologist at CHOC Children's, in a while labcoat on a gray background.
Dr. Mary Zupanc, Pediatric Epileptologist at CHOC Children’s
  1. There should be zero tolerance for seizures.

    Seizures are considered epilepsy when a child has had two or more unprovoked seizures—seizures that are not tied to a different underlying condition.

    When epilepsy is diagnosed, treatment should be initiated early. Some families are reluctant to treat their child’s epilepsy, often fearful that antiepileptic medication is worse than epilepsy itself. They worry about the side effects — that it will cause their child to have cognitive impairments and slow them down. However, repeated seizures can translate into progressive injury to the brain, with a decline in cognitive abilities and frequent psychosocial co-morbidities, including anxiety and depression. Furthermore, even if seizures are infrequent, there is a loss of independence for children and adolescents. An example would be an adolescent’s inability to obtain his/her driver’s license.

  2. Epilepsy is progressive.

    “Brain cells that seizure together network together,” Dr. Zupanc says, forming neuronal circuitry that hardwires the brain for continued seizures. Over time, there can be brain cell loss, cognitive decline, and important psychosocial consequences. Furthermore, when seizures continue, there is increased risk among those with epilepsy of sudden, unexpected death or other progressive neurological issues over the subsequent 20-30 years.

  3. Encourage parents to act quickly.

    Recurrent unprovoked seizures is the definition of epilepsy. Epilepsy should be treated and not ignored, for the reasons outlined above. Approximately 60-70% of epilepsy can be completely controlled with antiepileptic medication. Thirty percent of patients with epilepsy have intractable seizures, i.e. a failure to control the seizures with antiepileptic medications. These patients require more comprehensive care, including an evaluation for epilepsy surgery — at a Level IV Epilepsy Center, which is a designated center given only to those centers who provide multidisciplinary care with cutting-edge technology. Some parents fear that epilepsy surgery will cause serious neurological deficits. Most epilepsy surgeries are highly successful without detrimental effects to cognitive or motor functions. With epilepsy surgery, the risk of a severe and permanent injury is under 1%, and the risk of a minor or temporary injury is under 5%. Compared to the risks associated with years of recurrent seizures, the risks of epilepsy surgery are much lower than the risks of continued epilepsy.  

    The effectiveness of epilepsy surgery decreases significantly over time, especially for children who have had epilepsy for seven or more years. In addition, the plasticity of younger brains allows a transfer of functions to other parts of the brain — something adult brains cannot do as readily, Dr. Zupanc says.

    Because of this, she strongly encourages epilepsy surgery early, not waiting until a child is older.

  4. Delay in seizure treatment affects long-term psychological health.

    The psycho-social components of seizures are oftentimes just as important as the physiological ones, says Dr. Zupanc. Depression and anxiety occur in 50- to 60% of children with epilepsy, and there is also a notable increase in suicidal risk.

    These effects are increased when families wait to pursue recommended surgery, she says. Later in life, the surgery may remove the seizures, but the psychological effects are already deeply embedded.

  5. Seizure history should affect your referral choice.

    “It is so important for pediatricians to know that if a child’s epilepsy has not come under complete control after trying two or more antiepileptic medications, he/she should be referred to a higher level of epilepsy care, specifically a Level III-IV Epilepsy Center, as designated by the National Association of Epilepsy Centers,” says Dr. Zupanc. If the child is a young baby, the referral is even more urgent. “If a baby continues to have seizures after just one drug, he/she needs a referral to a Level III-IV epilepsy center immediately.”

    The care plan should include pediatric epilepsy specialists, epilepsy-trained neurosurgeons, state of the art neuroimaging tools, nurse practitioners, pharmacists, dieticians, social workers and neuropsychologists.

    “At CHOC, we treat epilepsy with a multidisciplinary team approach,” says Dr. Zupanc. Additional diagnostic tests are usually necessary to diagnose the appropriate epilepsy syndrome, determine if epilepsy surgery is an option, and/or outline an individualized, optimal treatment plan.

    Furthermore, all of those involved in the child’s care hold a comprehensive epilepsy conference to discuss complex cases and lay out the best possible strategy for achieving a seizure-free outcome.

Physician Wellness: Benefits of Gratitude

CHOC Physician Wellness Subcommittee Update
by Dr. Grace Mucci, Pediatric Neuropsychologist

Physician burnout is prevalent. According to the Mayo Clinic, up to 54% of doctors report at least one symptom of burnout. Further, it is estimated that the annual cost of that burnout is $4.6 billion per year in the form of physician turnover and reduced clinical hours, according to a study recently published by the Annals of Internal Medicine.

The experience of burnout results in feelings of cynicism, detachment from work, low sense of personal accomplishment, and emotional exhaustion. The reasons for burnout remain complicated, and a recent systematic review by the Journal of the College of Physicians and Surgeons Pakistan revealed both individual characteristics of physicians and variables within the working environment as contributory factors.

More specifically, work load appeared to be one of the main drivers and includes working hours, overnight duty, administrative duties, schedule and flexibility, and complexity of tasks. Feeling disconnected from colleagues or patients, poor communication or cooperation between colleagues and dealing with patients who disagree with treatment choices are additional sources of burnout.

Just as the causes of physician burnout are multi-factorial, the solutions encompass many strategies that include engaging in various lifestyle changes and systemic interventions.

One individual intervention that has been receiving more interest among researchers is gratitude. A 2017 study at UC Berkeley shows that the health benefits of expressing gratitude include increasing resilience to stress and boosting mental health. Gratitude also has been found to strengthen relationships and enhance mindfulness.

So, just how can we implement gratitude in everyday life? Here are a few ideas that can be applied easily:

  • Express gratefulness for the beauty in nature
  • Give thanks before eating food that has been prepared
  • Acknowledge service people you encounter throughout the day, such as a barista or worker
  • Keep a gratitude journal and write about all the things you’re thankful for prior to retiring for the night
  • Remember to tell your loved ones how much they are appreciated and one thing that you are grateful that they do every day
  • Surprise coworkers or even strangers by performing a random act of kindness
  • Keep a gratitude board where you document things you are thankful for, and be sure to review those items when you are having a difficult moment

At CHOC, several initiatives that promote this practice of expressing gratitude are underway. CHOC has partnered with the Institute for Healthcare Excellence (IHE) to offer an outstanding curriculum that helps build respect, trust and compassion, ultimately improving communication and empathy toward co-workers and patients and restoring joy to the practice of medicine.

In addition, CHOC’s Physician Wellness Subcommittee is busy planning a Wall of Gratitude in the physician dining room, where doctors can show gratitude and appreciation for their peers in real time.

We know that peer-to-peer recognition is important for strengthening the level of engagement and positive bonds among colleagues. We have all experienced the satisfaction of receiving kudos from our peers, and we want to make this easier and more visible to others. As we continue to advance these initiatives, be sure to practice those small but powerful strategies of expressing gratefulness in your everyday life.

Increasing Performance Excellence at CHOC: Meet Sharon Nielsen Wilson

CHOC Children’s has tapped a seasoned healthcare leader to further increase performance excellence across the pediatric healthcare system.

In her role as executive director of performance excellence, Sharon Nielsen Wilson will find ways to improve and enhance how CHOC patients and families are served across the organization at all levels. Further, Sharon is tasked with facilitating, understanding and supporting change throughout the organization.

“I am thrilled for this new opportunity at CHOC, and I look forward to building upon a strong culture of service and performance excellence to help propel CHOC forward as it strives to become the destination for children’s health,” Sharon said.

Sharon Nielsen Wilson, executive director of performance excellence

Bringing a clinical background as well as a dozen years of experience in improving systems and workflows, Sharon joined CHOC in May 2019 from Kaiser Permanente. She began work there in 2006 as a registered nurse and most recently served as director of performance improvement for its facility in Harbor City, Calif.

Sharon holds a bachelor’s degree in nursing from California State University, Dominguez Hills, and is currently pursing a master’s degree in quality assurance. She is also certified in change management through Implementation Management Association (IMA) and quality insurance through CSUDH.

We caught up with Sharon recently to learn more about her role and what she hopes to accomplish at CHOC.

What is Quality Improvement and why is it important to a healthcare organization?

Quality Improvement (QI) is a proactive and systematic approach to improve processes and systems.

QI models present a systematic, formal framework for establishing QI processes in your practice. Understanding and properly implementing QI is essential to a well-functioning practice and is necessary for improving efficiency, patient safety or clinical outcomes.

Examples of common QI models include:

  • IHI’s Model for Improvement: Thismodel uses plan-do-study-act (PDSA) cycles to test interventions on a small scale. The model combines two popular QI models: Total Quality Management (TQM) and Rapid-Cycle Improvement (RCI).
  • Six Sigma: A method of improvement that focuses on reducing variation.
  • Lean: An approach that reduces waste by decreasing non-value-added work in systems and processes.

How can all CHOC associates take an active role in improving performance excellence?

Associates can take an active role by taking advantage of the certification programs and partnership CHOC’s Performance Excellence team will be offering beginning this fall and together effectively identify, plan and execute improvement projects, deliver successful results and spread changes across the entire system.

The certification programs Performance Excellence will be offering are tailored to each level in the organization. The programs will help build a more solid foundation of knowledge and skills in the art and science of improvement within CHOC.

What do you see as key performance strengths for CHOC – and how can we build upon them to further enhance how we serve patients and families?

I see our associates’ engagement and dedication to CHOC’s mission as some of key performance strengths here at CHOC. Some ways to build on these strengths is to invest in our workforce and infuse performance excellence into our culture. As we continue to build reliability and efficiency into our processes and systems, we will be able to remove frustration and the potential for error and add value to the way we serve one another, our patients and their families.